Inside the secret world of IVF

Page Tools

There is big money to be made in the IVF industry and
many Australians are prepared to pay up, writes Amin
Abboud.

What is the real agenda of the IVF industry in the stoush over
Canberra's plan to roll back funding for IVF? Is it to ease the
pain of infertility for desperate couples or to insulate a cushy
industry from the pain of regulation?

Australia is the only country in the world with unlimited
government reimbursement for IVF. In Australia, the IVF industry is
worth at least $170 million and growing at a rate of 8 to 10 per
cent a year. When other services offered by the industry are
included, such as sex selection of the child, the figure is
considerably higher.

And the future looks bright for IVF impresarios with the help of
government subsidies. The chief executive of one Sydney IVF clinic
said last year: "In the future you will have sex for fun, but when
you want babies, you'll have IVF."

Over the past two weeks, the IVF industry has conducted an
aggressive campaign to embarrass the Howard Government into dumping
its plans to impose some reasonable restrictions on funding
fertility treatment.

Their public catchcry is that Health Minister Tony Abbott should
stay out of the bedrooms of Australians. Their real aim is to keep
Treasurer Peter Costello out of the wallets of IVF
practitioners.

Now it seems the Government has caved in by sending the proposed
restrictions to a committee.

Sandra Dill, a vocal participant in the debates, is CEO of a
group called Access Infertility Network. This group is partially
funded by biotech companies and IVF clinics, so they can hardly be
objective critics of any change in government funding. David
Malloy, president of the Queensland AMA, has also been very vocal.
He is a fertility doctor and part of the large Queensland Fertility
Group.

Professor George Annas, a leading US bioethicist at Boston
University, has made a very astute comment on the American IVF
industry: "The whole world of assisted reproduction has been
described, I think aptly, as kind of the Wild West mated with
American commerce and modern marketing. You have a variety of
highly professional individuals pitching their wares - their
success rates, their new technology, their cutting-edge technology
- to this highly susceptible group of infertile couples who are
almost willing to try anything, and almost pay any price to get a
baby. The industry has consistently resisted regulation."

The competition is not quite so vicious in Australia but the
general pattern is the same.

The debate in the media has focused on how many cycles of IVF
are needed for women to become pregnant. But the real issue here is
how many women would become pregnant anyway without IVF.

Just-released scientific reviews of IVF show that it is no more
effective than other treatment options for couples with unexplained
infertility - which is one third of infertile patients. The authors
of the prestigious Cochrane study conclude: "Until more evidence is
available, IVF may not be the preferred first line of treatment for
these couples and it might be more appropriate to continue with
less invasive options."

Genuinely infertile couples, who can often benefit from less
invasive techniques, are offered IVF instead. Michael Chapman,
chairman of the IVF directors group, admitted in an interview last
year that some people were conceiving through IVF who could get
pregnant by other means.

The problem is that the gatekeepers of infertility advice are
the reproductive industry themselves. Not surprisingly, about 3 per
cent of births in Australia are through IVF, three times the level
in the US and UK.

A compounding concern has been the creation of a false
infertility crisis through deliberate distortion of infertility
data. Sandra Dill claims that one in six people will need access to
IVF. This puts infertility at 15 per cent of the population - way
above even the most negative estimates of infertility in the
community.

Infertility is defined as the inability to conceive after 12
months of unprotected intercourse. It is a functional definition
and an inadequate way to define a medical condition. Many couples
conceive naturally after 12 months but can be erroneously labelled
as infertile.

Media reporting of these claims are particularly confusing to
women in their late 30s. In subtle ways, they are being told that
they are more likely to be infertile. This is a claim that is
greatly exaggerated. A study by David Dunson and his colleagues
published in the Journal of Obstetrics and Gynaecology in
2004 concluded that sterility did not increase with age. The
authors found that even the most difficult demographic, the 35 to
39 age group, could still conceive within a two-year period in nine
out of 10 cases. They just needed to relax and do what is naturally
necessary to conceive.

While sex is something that can be controlled by couples,
fertility is not. Infertility generates anxiety in many couples.
Exaggerated talk of growth in infertility makes couples insecure
and, rather than try to conceive naturally, throws them into the
arms of waiting IVF clinics. This is good news for clinics, of
course. With more fertile couples - who with time could have
conceived naturally - entering their IVF programs, the better their
success rates will be.

Infertility is one of the most protracted and painful problems
couples can experience. A willingness-to-pay study suggests that to
have a healthy child, couples would accept a 20 per cent risk of
death and would give up 29 per cent of their income. Couples in
this situation deserve the most comprehensive and objective advice
available.

All these factors call for a more comprehensive scientific
review of IVF than just the simple restrictions proposed by the
Government.

Dr Amin Abboud is a medical doctor and assistant lecturer
in medical ethics and health law at the University of New South
Wales. He is also director of Australasian Bioethics
Information.